Choosing and evaluating randomisation methods in clinical trials: a qualitative study

Bruce, Cydney L.; Iflaifel, Mais; Montgomery, Alan; Ogollah, Reuben; Sprange, Kirsty; Partlett, Christopher

Abstract

Background: There exist many different methods of allocating participants to treatment groups during a randomised controlled trial. Although there is research that explores trial characteristics that are associated with the choice of method, there is still a lot of variety in practice not explained. This study used qualitative methods to explore more deeply the motivations behind researchers’ choice of randomisation, and which features of the method they use to evaluate the performance of these methods. Methods: Data was collected from online focus groups with various stakeholders involved in the randomisation process. Focus groups were recorded and then transcribed verbatim. A thematic analysis was used to analyse the transcripts. Results: Twenty-five participants from twenty clinical trials units across the UK were recruited to take part in one of four focus groups. Four main themes were identified: how randomisation methods are selected; researchers’ opinions of the different methods; which features of the method are desirable and ways to measure method features. Most researchers agree that the randomisation method should be selected based on key trial characteristics; however, for many, a unit standard is in place. Opinions of methods were varied with some participants favouring stratified blocks and others favouring minimisation. This was generally due to researchers’ perception of the effect these methods had on balance and predictability. Generally, predictability was considered more important than balance as adjustments cannot be made for it; however, most researchers felt that the importance of these two methods was dependent on the design of the study. Balance is usually evaluated by tabulating variables by treatment arm and looking for perceived imbalances, predictability was generally considered much harder to measure, partly due to differing definitions. Conclusion: There is a wide variety in practice on how randomisation methods are selected and researcher’s opinions on methods. The difference in practice observed when looking at randomisation method selection can be explained by a difference in unit practice, and also by a difference in researchers prioritisation of balance and predictability. The findings of this study show a need for more guidance on randomisation method selection.

Citation

Bruce, C. L., Iflaifel, M., Montgomery, A., Ogollah, R., Sprange, K., & Partlett, C. (2024). Choosing and evaluating randomisation methods in clinical trials: a qualitative study. Trials, 25(1), Article 199. https://doi.org/10.1186/s13063-024-08005-z

• Journal Article Type: Article
• Acceptance Date: Feb 22, 2024
• Online Publication Date: Mar 20, 2024
• Publication Date: Mar 20, 2024
• Deposit Date: Mar 22, 2024
• Publicly Available Date: Mar 25, 2024
• Journal: Trials
• Electronic ISSN: 1745-6215
• Publisher: Springer Verlag
• Peer Reviewed: Peer Reviewed
• Volume: 25
• Issue: 1
• Article Number: 199
• DOI: https://doi.org/10.1186/s13063-024-08005-z
• Keywords: RCTs, Qualitative, Focus groups, Randomisation
• Public URL: https://nottingham-repository.worktribe.com/output/32752177
• Additional Information: Received: 7 July 2023; Accepted: 22 February 2024; First Online: 20 March 2024; : ; : No ethical approval was sought for this research as focus groups only contained researchers working in clinical trials units. A participant information sheet was included with the invitation for this study, and consent was verbally confirmed before focus group recording began.; : N/A.; : The authors declare that they have no competing interests.